改良Masquelet技术治疗大段掌指骨骨缺损的临床研究

Clinical study on the modified Masquelet technique in treating segmental metacarpophalangeal bone defects

目的探讨改良Masquelet技术治疗大段掌指骨骨缺损的可行性及疗效。方法选择2015年1月-2018年12月收治的9例符合手术适应证的大段掌指骨缺损病例,行改良Masquelet技术治疗:Ⅰ期彻底清创、体外预制中空抗生素聚甲基丙烯酸甲酯(polymethyl methacyrlate,PMMA)骨水泥模块填充骨缺损,皮肤软组织缺损或皮肤软组织条件较差者给予彻底清创皮瓣修复闭合创面,术后给予预防感染、观察患指血运等对症处理。Ⅱ期伤口愈合4~6周后去除骨水泥模块行自体松质骨植骨内固定术。结果9例术后随访6~24个月,骨折均愈合,平均愈合时间9.7周,术后未出现伤口感染等并发症。伤口甲级愈合,移植骨愈合,初步实现保指(肢)的目的并获得了部分功能。结论改良Masquelet技术治疗大段掌指骨骨缺损临床可行,效果确切,能够达到预期的保指(肢)并恢复部分功能的目的,具有操作简单、愈合快、适应证广、效果确切等优点,为大段掌指骨骨缺损的治疗提供一种新的理念。

Objective To explore the feasibility and clinical effect of modified Masquelet technique in treating segmental metacarpophalangeal bone defects.Methods Nine patients with segmental metacarpophalangeal defects,who were admitted from January 2015 to December 2018 and met the surgical indications,were enrolled into the present study.The first stage of the treatment was that the initial surgical treatment of the trauma was very thorough and the bone defect was filled with prefabricated hollow antibiotic PMMA bone cement module in vitro.For the skin and soft tissue defect or the skin and soft group with poor conditions,thorough debridement skin flap was used to repair the closed wound surface.After the operation,the symptomatic treatment such as prevention of infection and observation of the patient’s finger blood circulation were given.In the second stage,the operation of removing the bone cement module and autogenous cancellous bone grafting was performed 4-6 weeks after wound healing.Results All 9 patients in this group were followed up for 6 to 24 months after surgery.All the fractures healed with an average healing time of 9.7 weeks.For all patients,no infection or other complications occurred after surgery.The operated fingers initially realized the purpose of finger(limb)preservation and obtaining some functions.Conclusion The modified Masquelet technique is feasible and effective for treating segmental metacarpalphalangeal bone defects,It can achieve the expected purpose of finger(limb)preservation and partial function recovery.This method has the advantages of simple operation,rapid healing,wide indications and exact effect,which provides a new concept for the treatment of segmental metacarpalphalangeal bone defects.